Jahangir Abdullah, Rafay Khan Niazi Muhammad, Sahra Syeda, Javed Aneeqa, Krzyzak Michael
Internal Medicine, Northwell Health, Staten Island, USA.
Medicine, Northwell Health, Staten Island, USA.
Cureus. 2022 Jan 1;14(1):e20865. doi: 10.7759/cureus.20865. eCollection 2022 Jan.
A literature review shows scarce reports of myasthenic crises (MC) complicated by Takotsubo cardiomyopathy (TC). This patient cohort (0.11%) has higher all-cause mortality and prolonged in-hospital course. We present a rare case of a 72-year-old man who developed cardiogenic shock post-plasmapheresis for myasthenia crisis. He became hemodynamically unstable and developed acute respiratory failure requiring intubation 30 minutes after completion of plasma exchange. Serum troponin peaked at 3.19 ng/mL while an emergent 12-lead electrocardiogram (EKG) showed new-onset diffuse ST-segment elevation. Hypokinesis of the entire apex, anterior septum, mid-and apical inferior septum, and mid-and apical inferior wall consistent with Takotsubo cardiomyopathy was seen on bedside echocardiogram. The patient received a continuous infusion of norepinephrine and vasopressin. The hospital course was complicated by multiorgan failure and eventual demise. This case highlights MC and the potential of plasma exchange therapy to induce TC.
文献综述显示，关于重症肌无力危象（MC）并发应激性心肌病（TC）的报道极为罕见。该患者群体（占0.11%）的全因死亡率较高，住院时间延长。我们报告一例罕见病例，一名72岁男性在进行血浆置换治疗重症肌无力危象后发生心源性休克。血浆置换完成30分钟后，他出现血流动力学不稳定，并发展为急性呼吸衰竭，需要插管。血清肌钙蛋白峰值达到3.19 ng/mL，同时急诊12导联心电图（EKG）显示新发弥漫性ST段抬高。床旁超声心动图显示整个心尖、前间隔、中隔及心尖下间隔、中隔及心尖下壁运动减弱，符合应激性心肌病表现。患者接受了去甲肾上腺素和血管加压素持续静脉输注。住院过程中并发多器官功能衰竭，最终死亡。本病例突出了重症肌无力危象以及血浆置换疗法诱发应激性心肌病的可能性。
